| Doctor Name: | MR. MICHAEL ALLEN MOORE |
| NPI Number: | 1225039837 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 5601002580 |
| Business Practice Address: | 4200 Division Ave N Comstock Park, MI - 493219546 |
| Business Phone Number: | 6162521600 |
| Business Fax Number: | 6162521666 |
| Mailing Address: | 1925 Breton Rd Se, Suite 201 GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495064810 |
| Phone Number: | 6162521600 |
| Fax Number: | 6162521666 |
| NPI Enumeration Date: | 08/04/2005 |
| NPI Last Update Date: | 05/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601002580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |